Emergency Contact:

Please list an additional person whom we can contact if you cannot be reached.

Name

Phone

Insurance Company Name

Phone

Medical Information and Release:

If a parent cannot be reached in case of a medical emergency, we authorize the preschool permission to
obtain immediate medical care.

Is there any medical, developmental, or psychological information of which we should be aware? If so,please explain, indicating any professional help that your child receives or has received:

Allergies:

Does your child use an Epi-Pen?YesNo

Does your child have an IEP?YesNo

Are you currently working with Child Find?YesNo

Additional Information:

Ethnicity

Language spoken at home

Religion

Church presently attending

AGREEMENTS

1. We, the undersigned, have submitted the following: - a $75 non-refundable registration fee (submitted at the time of/with application) - A non-refundable deposit (1 month’s tuition) to be applied to tuition for the month of May 2019 (due March 15, 2019 for new families, and May 15, 2019 for returning families) - A non-refundable Events Fee of $50 due March 15, 2019 for new families, and May 15, 2019 for returning families. We understand that the remaining 8 tuition payments are due by the 10th of each month beginning September 2019. ALL fees are non-refundable. Parents may pay fees by cash, check, or online through VANCO Services on our website (click on the Tuition Button), splpreschool.org by automatic deduction or credit card.

2. We understand that to ensure placement, all fees/payments/forms must be submitted by the due dates.

3. Withdrawals and Tuition Refunds: Thirty (30) days written notice must be given to St. Paul’s Lutheran Preschool before withdrawing a child. Written notification of withdrawal prior to the start of school must be received by AUGUST 1, 2018 in order to receive a refund of the prepaid May tuition. NO exceptions will be made to this policy.

4. Extended Leave Policy: If a child takes an Extended Leave from the Preschool Program, the family is still responsible for paying all tuition fees due during the child’s period of absence. These fees must be paid to hold your child’s position in the Preschool. For example: If your child is gone during the months of November and December, you must pay the November and December tuition in order for your child to return to school in January. We acknowledge and accept the Withdrawal, Refund, and Extended Leave Policies stated here.

5. We give the Preschool permission to use photos of students in the Preschool’s newsletter, advertising materials, its web site and Facebook Page. (no names will be listed)